Pharmacologic: dipeptidyl peptidase-4 inhibitors
Adjunct with diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
Acts as a competitive inhibitor of dipeptidyl peptidase-4 (DPP4) which slows inactivation of incretin hormones, thereby increasing their concentrations and reducing fasting and postprandial glucose concentrations; Therapeutic Effects: Improved control of blood glucose.
Adverse Reactions/Side Effects
CNS: headache. CV: peripheral edema (↑ with thiazolidinediones). GI: abdominal pain, vomiting. Hemat: ↓ lymphocyte count. Endo: hypoglycemia (↑ with sulfonylureas). Misc: hypersensitivity reactions, including urticaria and facial edema.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) and skin reactions (rash, pruritus, urticaria, burning skin, exfoliation, swelling in the face). Notify physician immediately of these signs.
Be alert for signs of hypoglycemia, especially during and after exercise. Common neuromuscular signs include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Report persistent or repeated episodes of hypoglycemia to the physician.
Assess blood pressure periodically (See Appendix F). A sudden or sustained increase in blood pressure (hypertension) may indicate problems in diabetes management and should be reported to the physician.
Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.
Implement aerobic exercise and endurance training programs to maintain optimal body weight, improve insulin sensitivity, and reduce the risk of macrovascular disease (heart attack, stroke) and microvascular problems (reduced blood flow to tissues and organs that causes poor wound healing, neuropathy, retinopathy, and nephropathy).
Encourage patient to monitor blood glucose before and after exercise, and to adjust food intake to maintain normal glycemic levels.
Emphasize the importance of adhering to nutritional guidelines and the need for periodic assessment of glycemic control (serum glucose and glycosylated hemoglobin levels) throughout the management of diabetes mellitus.
Advise patient about symptoms of hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; unusual thirst). Drug dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.
Instruct patient to report other troublesome side effects such as severe or prolonged headache or GI problems (vomiting, abdominal pain).
Absorption: Well absorbed following oral administration.
Metabolism and Excretion: Metabolized by the liver via the P450 3A4/5 (CYP3A4/5) enzyme system, with conversion to 5-hydroxysaxagliptin, ...